Acute kidney injury in patients with acute coronary syndromes

Abstract

Acute kidney injury (AKI) is increasingly being seen in patients with acute coronary syndromes (ACSs). This condition has a complex pathogenesis, an incidence that can reach 30% and it is associated with higher short-term and long-term morbidity and mortality. Nevertheless, AKI is still characterised by lack of a single accepted definition, unclear pathophysiology understanding and insensitive diagnostic tools that make its detection difficult, particularly in the setting of ACS. Recent data suggested that patients with AKI during ACS, even those in whom renal function seems to fully recover, face an increased, persisting risk of future AKI and may develop chronic kidney disease. Thus, in these patients, nephrology follow-up, after hospital discharge, and secondary preventive measures should possibly be implemented. In this review, we aim at providing a framework of knowledge to increase cardiologists' awareness of AKI, with the goal of improving the outcome of patients with ACS.

Impact of KDIGO-Defined Acute Kidney Injury on Mortality after Percutaneous Coronary Intervention for Acute Myocardial Infarction

“…Beside patient characteristics, procedural data and outcome characteristics were included in the multivariable regression model to elucidate the risk factors predicting AKI. As previously found, cardiogenic shock on admission, diabetes, hypertension, renal dysfunction, STEMI, heart failure [2, 5, 15, 17, 18], and contrast volume/eGFR ratio predicted AKI [5, 19]. In fact, this ratio seems to have a greater potential to discriminate between the patients who are at higher risk of AKI than the contrast volume alone since it includes 2 parameters (contrast volume and eGFR) that both predispose to AKI [19, 20].…”

Development of a novel score to predict the risk of acute kidney injury in patient with acute myocardial infarction

“…Acute kidney injury (AKI) is common in patients with acute myocardial infarction (AMI), with an incidence as high as 30 % [1]. AKI in this setting is associated with short-and long-term adverse events.…”

“…Not only is there a pre-renal component to this injury but also ischemia itself causes alterations in epithelial cell function and structure in addition to microvasculopathy and interstitial inflammation [6]. Changes in volume status, medications, atheroembolism during percutaneous coronary intervention (PCI) or intra-aortic balloon pump counter-pulsation, and bleeding are all common conditions in patients with AMI that may contribute to the development of AKI [1]. In addition, various inflammatory and metabolic markers are implicated in the pathogenesis of AKI in patients with AMI [5].…”

“…Beyond the widely recognized negative impact of contrast volume, the key mechanisms in AKI pathogenesis include systemic and renal hemodynamic changes secondary to impaired cardiac output, arrhythmias, and increased venous congestion [1,6]. The sudden myocardial injury in ST-segment elevation myocardial infarction (STEMI) is often complicated by cardiogenic shock or unstable arrhythmias which can compromise cardiac output [6].…”

Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

“…Acute kidney injury (AKI) is a frequent complication of acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) that critically affects in‐hospital and long‐term outcome 1, 2. In‐hospital mortality has been shown to be 20 times higher in AMI patients who experience AKI compared with those without this complication 3.…”